Article Text
Abstract
Objective Severe infections are a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Our primary objective was to use data from a large Spanish cohort to develop a risk score for severe infection in SLE, the SLE Severe Infection Score (SLESIS) and to validate SLESIS in a separate cohort of 699 British patients.
Design and setting Retrospective longitudinal study in a specialist tertiary care clinic in London, UK.
Participants Patients fulfilling international classification criteria for SLE (n=209). This included 98 patients who had suffered severe infections (defined as infection leading to hospitalisation and/or death) and 111 randomly selected patients who had never suffered severe infections.
Outcomes We retrospectively calculated SLESIS at diagnosis for all 209 patients. For the infection cases we also calculated SLESIS just prior to infection and compared it to SLESIS in 98 controls matched for disease duration. We carried out receiver operator characteristic (ROC) analysis to quantify predictive value of SLESIS for severe infection.
Results Median SLESIS (IQR) at diagnosis was higher in the infection group than in the control group (4.27 (3.18) vs 2.55 (3.79), p=0.0008). Median SLESIS prior to infection was higher than at diagnosis (6.64 vs 4.27, p<0.001). In ROC analysis, predictive value of SLESIS just before the infection (area under the curve (AUC)=0.79) was higher than that of SLESIS at diagnosis (AUC=0.63).
Conclusions We validated the association of SLESIS with severe infection in an independent cohort. Calculation of SLESIS at each clinic visit may help in management of infection risk in patients with SLE. Prospective studies are needed to confirm these findings.
- systemic lupus erythematosus
- severe infection
- risk score
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Footnotes
Contributors AR and BTS designed the study. IR-F, JMP-R and VdC developed the SLESIS score and advised on design of the study. BTS, AR, CW and DI collected the data. BTS and VdC carried out the statistical analysis. BTS, JMP-R, IR-F, VdC, DI and AR all took part in interpreting the results and writing the final manuscript.
Funding This work was supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre and the Spanish Foundation of Rheumatology (FER).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.
Patient consent for publication Not required.